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Magnitude of surgical burden associated with pediatric intestinal failure: a multicenter cohort analysis
Faraz A Khan1, Paul D Mitchell2, Jeremy G Fisher1
1Center for Advanced Intestinal Rehabilitation, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA.
Insights
Infants with pediatric intestinal failure (PIF) undergo numerous surgeries, with higher surgical burdens linked to more septic events. Treatment at transplant-capable centers may reduce the number of abdominal operations for these children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Pediatric intestinal failure (IF) necessitates extensive surgical interventions.
- The specific surgical burden and associated patient factors in IF are not well understood.
Purpose of the Study:
- To investigate the number and types of surgical procedures in infants with pediatric intestinal failure (PIF).
- To identify patient and center characteristics associated with the surgical burden in PIF.
Main Methods:
- Retrospective review of data from the Pediatric Intestinal Failure Network (PIFCON) study.
- Inclusion of infants from 14 multidisciplinary IF programs with >60 days of parenteral nutrition dependence.
Main Results:
- 272 infants underwent a median of 4.0 abdominal procedures over 33.5 months.
- Higher surgical frequency (≥5 operations) correlated with increased septic events (P<0.01).
- Treatment at transplant-capable centers was associated with fewer than 2 abdominal operations (OR 0.37).
Conclusions:
- Surgical practices in PIF vary based on individual and center-specific factors.
- Further research is needed to optimize care and reduce the healthcare burden for infants with IF.
Background:
Pediatric intestinal failure (IF) patients require many surgical procedures over the course of their illness. The number and variety of surgical procedures, as well as patient characteristics associated with this burden of surgical procedures, remain largely unknown.
Methods:
Data from a large, multicenter retrospective study of pediatric intestinal failure (PIFCON) were reviewed. Infants from 14 multidisciplinary IF programs were enrolled, with study entry defined as PN dependence for >60days.
Results:
A total of 272 infants were followed for a median (IQR) of 33.5 (16.2, 51.5) months, during which time they underwent 4.0 (3.0, 6.0) abdominal surgical procedures. Intestinal resections were performed in 88/97 (92%) necrotizing enterocolitis patients versus 138/175 (80%) in non-NEC patients (P<0.05). Patients who underwent ≥5 operations had more septic events, compared to those who underwent ≤2 operations (3 (1, 6) versus 1 (0, 3), respectively, P<0.01). Patients treated at centers with transplantation capability had lower odds of undergoing >2 abdominal operations [OR 0.37 (95% CI: 0.21, 0.65)] after multivariable adjustment.
Conclusions:
Individual and center-specific characteristics may help determine surgical practices experienced by infants with IF. Further study may delineate additional details about the nature of these characteristics, with the goal of optimizing patient care and minimizing individual and overall healthcare burden.
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